Kratom is derived from an evergreen tree in the coffee family that is native to Southeast Asia.
This tree’s leaves are often chewed and used as a stimulant for workers in the tree’s native country.
They may also be brewed into a tea and used as a sedative and analgesic.1
The different effects of Kratom depend on the dose ingested. The low doses obtained from chewing on the leaves cause stimulation, including increased alertness, talkativeness, and physical energy. At higher doses, obtained from drinking Kratom tea, sedation occurs.2
Although Kratom is prohibited in Malaysia due to the Poisons Act of 1952, it is still widely used because it grows natively, and teas are readily available locally.3
Kratom Survey 2016
Kratom has gained popularity in the United States in recent years. An anonymous online survey conducted in October of 2016 attempted to answer several questions regarding its use. The survey was sent to 10,000 current Kratom users, and 8049 replied. Here are some of the findings.4
Most Kratom users are 31-50 years old.
They use Kratom for the following reasons:
- Treatment of pain (68%)
- Emotional or mental conditions (66%)
- Treatment of withdrawal symptoms associated with prescription opiate use.
Most side effects involve nausea or constipation.
Mechanism of Action
The active chemicals present in Kratom are mitragynine and 7-hydroxymitragynine. These alkaloids are thought to work on opioid receptors as partial agonists.5
These actions are too complex to discuss here, but it appears that these compounds can provide opiate effects with less respiratory depression.6
Opiates are the main medications used to treat severe pain. Opiates also cause many adverse effects, such as respiratory depression, constipation, drowsiness, and dizziness.
The alkaloids found in Kratom may prove to be very beneficial as pain medications because respiratory depression is dangerous, and can cause death in opiate overdose.
Kratom Euphoria
The primary purpose of this post is to describe the euphoric effects of Kratom. Knowing that the alkaloids in this plant interact with opiate receptors, it is not surprising that euphoria can occur. The effects of Kratom can vary between individuals, but some of the euphoric effects I could locate include.
The kratom user’s guide. Sage Wisdom Web site. http://www.sagewisdom.org/kratomguide.html. Accessed August 27, 2020.
- A general feeling of comfortable pleasure.
- Less sensitive to physical and emotional pain.
- May experience pleasant daydreams.
- Increased appreciation of music.
It should be noted that the above experiences were described by those who had Kratom products for sale. I have no personal experience with this substance, so I am unable to confirm such effects.
Side Effects of Kratom
Kratom can cause several adverse effects. When used in doses up to 5 grams, Kratom may cause:7
- Nausea and Vomiting
- Loss of appetite
- Poor muscle coordination
- Increased urination
- Dizziness
At higher doses, 8 grams or more, one may experience:8
- Rapid heart rate
- Constipation
- Sedation
- Fluctuations in blood pressure
- Sweating
- Dry mouth
There have also been case reports of other serious side effects of Kratom. One of the most concerning is liver damage. One case report involved a 25-year-old man who ingested between one to six teaspoons of Kratom powder daily for two weeks. This patient developed intense abdominal pain, brown urine, itching, and profound jaundice.9
There have been reports of withdrawal symptoms occurring after the habitual use of Kratom.10
Kratom has also been implicated in at least 91 drug-related deaths.11
It is important to note that multiple drug exposures were present in most of these cases.
Kratom Drug Interactions
CNS Depressants – Combining Kratom with other CNS depressants may lead to fatal respiratory depression. Fatalities have been reported in patients who have ingested Kratom along with the mu-receptor agonist O-desmethyltramadol.14
Drugs that are metabolized by cytochrome P450 enzymes – Many medications are metabolized in the liver through the cytochrome P450 enzyme system. Kratom has been shown to inhibit this process.15
The combination of Kratom with C-450 substrates may increase blood levels and lead to toxic effects. There are too many affected medications to list here, but they can be found at the TRC natural medicines databaseTM.
Modafanil (ProvigilTM) – When Kratom is ingested along with modafinil, the risk of seizures may increase.17
Quetiapine (SeroquelTM) – The combination of Kratom and quetiapine may lead to increased quetiapine plasma levels. This is also due to C-P450 enzyme inhibition. A 27-year-old male was found deceased due to this combination.18
Kratom has been used in Southeast Asia for hundreds of years.19
It has gained popularity here in the USA and is widely available in smoke shops and through the internet.
I believe that Kratom’s alkaloids may lead to alternative medications to treat pain in the future. The fact that these substances can treat pain and cause less respiratory depression is promising.
After researching Kratom, I cannot recommend its use.
Although it may be beneficial for those suffering from opiate withdrawal, the adverse effects can be severe.
It also seems to be another substance used to “get high.” Using substances to achieve a euphoric effect is never a good idea.
Another issue with Kratom is that it is often mixed with other mind-altering substances or medications. This can lead to toxic blood levels. There are several case reports involving Kratom, causing death and liver damage when combined with other substances.
If you have any questions regarding Kratom or any other medication or natural product, please contact me. I hope you all have a great week and please stay safe out there!
Michael J. Brown, RPh, BCPS, BCPP
Mr. Brown is a Clinical Pharmacist specializing in pharmacotherapy and psychiatry.
Feel free to send Michael a message using this link.
Disclosure: This post may contain affiliate links, meaning, at no additional cost to you, I may earn a commission if you click on, or make a purchase through a third-party link.
Brown PN, Lund JA, Murch SJ. A botanical, phytochemical and ethnomedicinal review of the genus Mitragyna korth: implications for products sold as Kratom. J Ethnopharmacol. 2017;202:302–325.
- https://www.dea.gov/sites/default/files/2020-06/Kratom-2020_0.pdf
- Singh D, Narayanan S, Vicknasingam B. Traditional and non-traditional uses of Mitragynine (Kratom): a survey of the literature. Brain Res Bull. 2016;126(Pt 1):41–46. doi:10.1016/j.brainresbull.2016.05.004
- Grundmann O. Patterns of Kratom use and health impact in the US-Results from an online survey. Drug Alcohol Depend. 2017;176:63-70. doi:10.1016/j.drugalcdep.2017.03.007
- Kruegel AC, Gassaway MM, Kapoor A, et al. Synthetic and receptor signaling explorations of the mitragyna alkaloids: mitragynine as an atypical molecular framework for opioid receptor modulators. J Am Chem Soc. 2016;138(21):6754–6764. doi:10.1021/jacs.6b00360.
- Macko E, Weisbach JA, Douglas B. Arch. Int. Pharmacodyn. Ther. 1972; 198:145–161. [PubMed: 4626477] Kruegel et al. Page 13 J Am Chem Soc. Author manuscript; available in PMC 2016 December 27.
- https://naturalmedicines.therapeuticresearch.com/databases/food,-herbs-supplements/professional.aspx?productid=1513
- Kruegel AC, Grundmann O. The medicinal chemistry and neuropharmacology of Kratom: A preliminary discussion of a promising medicinal plant and analysis of its potential for abuse.Neuropharmacology. 2017. pii: S0028-3908(17)30393-3
- Kapp FG, Maurer HH, Auwarter V, Winkelmann M, Hermanns-Clausen M. Intrahepatic cholestasis following abuse of powdered Kratom (Mitragyna speciosa). J Med Toxicol 2011;7(3):227-231
- McWhirter L, Morris S. A case report of inpatient detoxification after kratom (Mitragyna speciosa) dependence. Eur Addict Res. 2010;16(4):229-231. doi:10.1159/000320288
- FDA Adverse Event Reporting System: Kratom Deaths. February 6, 2018. https://www.fda.gov/downloads/Drugs/GuidanceComplianceRegulatoryInformation/CDERFOIAElectronicReadingRoom/UCM595575.pdf. Accessed March 6, 2018.
- Olsen EO, O'Donnell J, Mattson CL, Schier JG, Wilson N. Notes from the field: Unintentional drug overdose deaths with Kratom detected - 27 States, July 2016-December 2017. MMWR Morb Mortal Wkly Rep. 2019;68(14):326-327.
- Gershman K, Timm K, Frank M, et al. Deaths in Colorado Attributed to Kratom. N Engl J Med. 2019 January 3;380(1):97-98.
- Kronstrand R, Roman M, Thelander G, Eriksson A. Unintentional fatal intoxications with mitragynine and O-desmethyltramadol from the herbal blend Krypton. J Anal Toxicol. 2011;35(4):242-247.
- Kong WM, Chik Z, Ramachandra M, et al. Evaluation of the effects of Mitragyna speciosa alkaloid extract on cytochrome P450 enzymes using a high throughput assay. Molecules. 2011;16(9):7344-7356.
- https://naturalmedicines.therapeuticresearch.com/databases/food,-herbs-supplements/professional.aspx?productid=1513
- Boyer EW, Babu KM, Adkins JE, McCurdy CR, Halpern JH. Self-treatment of opioid withdrawal using Kratom (Mitragynia speciosa korth). Addiction 2008;103(6):1048-1050.
- Hughes RL. Fatal combination of mitragynine and quetiapine - a case report with discussion of a potential herb-drug interaction. Forensic Sci Med Pathol. 2019 Mar;15(1):110-113.
- Grewal KS. Observations on the pharmacology of mitragynine. J Pharmacol Exp Ther. 1932;46:251-271.
- Jansen KL, Prast CJ. Ethnopharmacology of Kratom and the Mitragyna alkaloids. J Ethnopharmacol. 1988;23(1)115-119.
